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The service patterns of a racially, ethnically, and linguistically diverse housestaff. PURPOSE: To explore whether racial and ethnic concordance in the service patterns of residents is as disproportionate as it is among practicing physicians, and to examine the effect of residents' second-language proficiencies on these patterns. METHOD: The authors conducted a cross-sectional study of billing data from 13,681 patient visits to resident continuity clinics at a Northern California pediatric medical center between May 1998 and October 1999. For each racial or ethnic group of patients, the proportion of patient visits to race-concordant residents was compared with the proportion of visits to all residents of other races or ethnicities. Multivariate logistic regression analyses (adjusted for confounders and residents' second-language proficiency) were used to measure the concordance of race or ethnicity in patient-resident pairs. RESULTS: For all visits made to African-American, Asian, and Latino residents, the percentage of race-concordant visits exceeded the percentage of race-discordant visits for each patient group. In adjusted regression models, African-American, Asian, and Latino patients were more likely to visit residents of the same race or ethnicity. White patients were not more or less likely to visit white residents. When adjusted for residents' second-language proficiencies, Latino patients remained more likely to visit Latino residents and Asian patients remained more likely to see Asian residents. In analyses restricted to residents reporting fluency in Spanish, Latino patients were more likely to visit Latino residents. CONCLUSION: African-American, Asian, and Latino pediatric residents disproportionately served more patients from their own racial or ethnic backgrounds. This service pattern was not completely explained by physicians' second-language proficiencies. A resident's race or ethnicity may reflect a unique set of skills that is highly valued by patients or health care systems. am

The influence of native-language phonology on lexical access: exemplar-Based versus abstract lexical entries. This study used medium-term auditory repetition priming to investigate word-recognition processes. Highly fluent Catalan-Spanish bilinguals whose first language was either Catalan or Spanish were tested in a lexical decision task involving Catalan words and nonwords. Spanish-dominant individuals, but not Catalan-dominant individuals, exhibited repetition priming for minimal pairs differing in only one feature that is nondistinctive in Spanish (e.g.,[see text]), thereby indicating that they processed these words as homophones. This finding provides direct evidence both that word recognition uses a language-specific phonological representation and that lexical entries are stored in the mental lexicon as abstract forms. ps.

Language-specific, hearing-related changes in vowel spaces: a preliminary study of English- and Spanish-speaking cochlear implant users. A study investigates the role of hearing in vowel productions of postlingually deafened cochlear implant users. Two hypotheses were tested that derive from the view that vowel production is influenced by competing demands of intelligibility for the listener and least effort in the speaker: 1) Hearing enables a cochlear implant user to produce vowels distinctly from one another; without hearing, the speaker may give more weight to economy of effort, leading to reduced vowel separation. 2) Speakers may need to produce vowels more distinctly from one another in a language with a relatively "crowded" vowel space, such as American English, than in a language with relatively few vowels, such as Spanish. Thus, when switching between hearing and non-hearing states, English speakers may show a tradeoff between vowel distinctiveness and least effort, whereas Spanish speakers may not. DESIGN: To test the prediction that there will be a reduction of average vowel spacing (AVS) (average intervowel distance in the F1-F2 plane) with interrupted hearing for English-speaking cochlear implant users, but no systematic change in AVS for Spanish cochlear implant users, vowel productions of seven English-speaking and seven Spanish-speaking cochlear implant users, who had been using their implants for at least 1 yr, were recorded when their implant speech processors were turned off and on several times in two sessions. RESULTS: AVS was consistently larger for the English speakers with hearing than without hearing. The magnitude and direction of AVS change was more variable for the Spanish speakers, both within and between subjects. CONCLUSION: Vowel distinctiveness was enhanced with the provision of some hearing in the language group with a more crowded vowel space but not in the language group with fewer vowels. The view that speakers seek to minimize effort while maintaining the distinctiveness of acoustic goals receives some support. eh.